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![]() Interim Guidelines for Prevention and Control of Staphylococcal Infection Associated with Reduced Susceptibility to VancomycinStaphylococci are one of the most common causes of community- and hospital-acquired infection. In many U.S. hospitals, strains of staphylococci (i.e., Staphylococcus aureus or coagulase-negative staphylococci) are resistant to all available antimicrobials except vancomycin. Rare cases of infection in the United States (1) have been caused by coagulase-negative staphylococci with reduced susceptibility to vancomycin (minimum inhibitory concentration {MIC} greater than or equal to 8 ug/mL) * (2). In May 1996, an infection caused by a strain of S. aureus with reduced susceptibility to vancomycin (MIC=8 ug/mL) was diagnosed in a patient in a hospital in Japan (3,4); no such infections have been reported in the United States. Although the strain from Japan was not fully resistant to vancomycin (i.e., MIC greater than or equal to 32 ug/mL), its appearance increases the likelihood that fully resistant strains may emerge. Because the occurrence of fully vancomycin-resistant staphylococcal infection in a hospital could result in serious public health consequences, CDC and the Hospital Infection Control Practices Advisory Committee have developed interim guidelines to direct medical and public health responses when isolates of staphylococci with reduced vancomycin susceptibility are identified. This report describes these interim guidelines, which include steps to 1) decrease the likelihood that staphylococci with reduced vancomycin susceptibility will emerge; 2) recognize the occurrence of staphylococci with reduced vancomycin susceptibility; 3) obtain information about investigational antimicrobials for treating either patients infected with fully vancomycin-resistant staphylococci or patients infected with staphylococci with intermediate vancomycin resistance for whom conventional therapy fails; and 4) implement interim infection-control measures. To effectively implement these interim guidelines, each health-care facility should develop a plan based on these guidelines in which responsibilities for critical departments and personnel are clearly delineated. Preventing the Emergence of Vancomycin Resistance Antimicrobial use is a major risk factor for the emergence of antimicrobial-resistant pathogens. Reduction of overuse and misuse of antimicrobials will decrease the risk for emergence of staphylococci with reduced susceptibility to vancomycin. Medical and ancillary staff members who are responsible for pharmacy formulary decisions should review and restrict use of vancomycin (5) and ensure that use of other antimicrobials is appropriate. Detecting Staphylococci with Reduced Vancomycin Susceptibility Use of recommended laboratory methods (including media and incubation methods, antimicrobial susceptibility testing methods, and susceptibility breakpoints) for identifying such strains is essential.
Obtaining Investigational Antimicrobials The susceptibility pattern of a particular staphylococcus strain, the site of infection, and the response to conventional therapy is important in determining the need for investigational antimicrobials to treat infections caused by staphylococci with reduced vancomycin susceptibility. Several antimicrobial agents in clinical development may be useful in treating vancomycin-resistant enterococci and methicillin-resistant S. aureus. Some of these agents also may be useful in treating infections with S. aureus with reduced susceptibility to vancomycin. The usefulness of any antimicrobial agent will depend on the resistance mechanism and susceptibility pattern of the S. aureus strain. CDC and the Food and Drug Administration (FDA) are working to improve access by clinical providers to investigational agents that may be useful for treating patients with confirmed infections with S. aureus strains with reduced susceptibility to vancomycin. Physicians treating infections caused by staphylococci with reduced vancomycin susceptibility can obtain information about investigational drug therapies from FDA's Division of Anti-Infective Drug Products, telephone (301) 827-2120. The physician will be requested to send the isolate to CDC for microbiologic and epidemiologic evaluation. Preventing the Spread of Staphylococci with Reduced Vancomycin Susceptibility To prevent the spread of staphylococci with reduced susceptibility to vancomycin within and between facilities and to minimize the potential for the organism to become endemic, the following steps should be taken whenever such an organism is isolated:
Reported by: Hospital Infection Control Practices Advisory Committee. Div of Anti-Infective Drug Products and Div of Special Pathogens and Immunologic Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration. Hospital Infections Program, National Center for Infectious Diseases, CDC. References
* National Committee for Clinical Laboratory Standards breakpoints: susceptible, less than or equal to 4 ug/mL or zone size greater than or equal to 12 mm; intermediate, 8-16 ug/mL or zone size 10-11 mm; and resistant, greater than or equal to 32 ug/mL or zone size less than or equal to 9 mm. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
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This page last reviewed 5/2/01
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